By Amy Pappas, a physiotherapist and Pilates instructor at The Physio Pilates Movement

Abdominal separation (rectus diastasis) is a normal part of pregnancy. All women who reach full-term in their pregnancy will have a degree of separation by delivery. This involves the thinning and stretching of the connective tissue that joins the two sides of the abdominal wall (six-pack muscles) together. Some women will recognise the separation themselves as a doming or triangular shape appearing down the middle of their stomach when sitting up in bed. It is not usually painful.

While there is nothing we can do to prevent the separation from occurring, we can reduce further strain on the abdominal muscles and connective tissue during pregnancy with the following:

1. Avoid any sit-up motion, such as by rolling through your side to get in and out of bed.
2. Avoid any activity where you need to hold your breath or strain through your abdominal muscles. When lifting think “blow and go” to use your exhale.
3. Avoid straining on the toilet, discuss any constipation with your medical team
4. Maintain good posture and alignment in standing and sitting – ribs stacked over pelvis
5. Take rest breaks where possible, including side-lying with pillow between knees if you are unable to maintain good posture in sitting.
6. Ensure you are able to activate your deep core and pelvic floor muscles correctly and continue strengthening them through the pregnancy. Pilates exercises are very helpful for this.
7. Support garments, such as pregnancy SRC tights or tubigrip, can help support the weight of the growing stomach and reduce pain

After delivery, your abdominal separation may be checked by your midwife or visiting physiotherapist in a hospital/home visit. This is usually a quick check involving them gently pressing their fingers down into your belly button to assess the size and depth of a potential gap. If your separation is moderate (usually three fingers or greater), they will recommend you seek further individual assessment and treatment with a women’s health physiotherapist at six weeks post-partum. Individual assessment is really important as every woman recovers differently from their separation.

In the first few weeks after birth you can help your stomach recover by:

1. Wearing compression over your stomach daily. We can measure you for SRC recovery garments from 36 weeks pregnant so you can pack them in your hospital bag or wait until after delivery for a fitting. They will feel tight to put on initially, wear when comfortable.
2. Continue to roll through your side for moving in and out of bed.
3. Rely on your upper and lower body for activities such as standing up from a chair.
4. Maintain good posture when feeding. A feeding pillow can help with this.
5. Take regular lying down rest to take a load off the body.
6. Share physical tasks such as bathing and settling baby with partner/visitors.
7. Gentle walks, start with 5 minutes on flat ground and gradually build weekly.
8. REST. Give your body time to heal.

In your women’s health physiotherapy review we will perform a thorough assessment of your abdominal muscles, including use of real-time ultrasound to show you how your core is functioning and again measure the width and depth of your gap.

We will also assess pelvic floor and general muscle strength. This can involve an internal pelvic floor assessment or real-time ultrasound machine. This assessment will then guide your rehabilitation exercise program, which can be completed at home or in our semi-private group classes at Helensburgh or Stanwell Park.

For post-birth exercises from The Physio Pilates Movement, check out the Flame's article here. 

For more information on  The Physio Pilates Movement, visit the website